1532 (2) � 272I _
NO. STREET - LOT NO.
PATI kR ELECTRICAL PERMIT
GGA Fl CUPERTINO
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Dated Permit No.
rl � Fee S oqoZ
Applicatton�is�}i ebp�i t� �ty of Cupertino for a permit to install electrical
wiring and/or fixtures as listed on the reverse side hereof, and agrees to install said
wiring and/or fixtures in accordance'with the provisions of the Electrical Code ofi the
r nj) City of Cupertino, and all other laws applicable.thereto.
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77 .7,
a Owner r-� "'� Actress tl 13d
By nr f �' flGCrfZL c i�{d'd ess 3X : : rfr
vvCC// CONTRACTOR, AGENT
Phone: C'. ti I y� 5 Approv
ELECTRICAL INSPE
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